Mentally Ill Often Targets of Violence

Action Points

This meta-analysis of 21 studies found an increased prevalence of violence against adults with disabilities, particularly against those with mental illness.

Note that there was considerable heterogeneity among studies, which were mostly conducted in higher-income countries.

One in four people with mental illness experiences violence of some type in a given year, a much higher rate than experienced by the rest of the population, a meta-analysis determined.

The odds of a person with mental illness experiencing physical, sexual, or domestic violence were 3.86-fold higher than among adults without any disabilities, although with a wide confidence interval that didn't reach statistical significance, Mark A. Bellis, DSc, of Liverpool John Moores University in Liverpool, England, and colleagues found.

Violence against individuals with other disabilities was common as well, the group reported online in The Lancet.

The prior-year prevalence rate was 6% among those with intellectual impairment and 3% among those with other nonspecific disabilities.

Instead of compassion toward adults with disabilities as victims of violence, the public often fears violence from them, particularly those with severe mental illness, Esme Fuller-Thomson, and Sarah Brennenstuhl, both of the University of Toronto, noted in an accompanying editorial.

More research is clearly needed, but screening appears appropriate, they suggested.

"Antiviolence programs should be implemented in disability-related settings, including training for staff who are often uninformed about topics related to violence," they wrote. "In mental health centers, skill-based violence prevention programs for those with severe mental illness are recommended to reduce the risk of revictimization."

One reason for the particular vulnerability of those with mental illnesses may be the interpersonal difficulties inherent to these conditions, the researchers noted.

Other contributors to violence against individuals with disabilities seem to be exclusion from education and employment, the need for personal assistance in daily living, reduced physical and emotional defenses, communication barriers, social stigma, and discrimination, they added.

The meta-analysis included 21 studies reporting violence prevalence estimates against disabled adults (primarily 18 and older) from 1990 through 2010 that fit strict selection criteria for quality and reporting that would enable their results to be pooled.

The odds of physical, sexual, or intimate partner violence in the prior 12 months compared with individuals without disability were:

31% higher for people with nonspecific impairments (95% CI 0.93 to 1.84)

60% higher for people with intellectual impairments (95% CI 1.05 to 2.45)

286% higher for the mentally ill (95% CI 0.91 to 16.43)

The researchers cautioned that their inclusion criteria probably underestimated the prevalence of violence against people with disabilities.

"Lifetime exposure to violence, and the proportions of individuals with disability who are directly threatened with violence or otherwise live in fear of becoming a victim, are likely to be substantially higher than our estimate," they wrote in the paper.

Their search turned up no studies of violence against individuals with intellectual handicaps in institutional settings, though such persons often are considered especially vulnerable. Nor were any studies of individuals with sensory impairments included, because none met the inclusion criteria.

Another reason for the conservative estimate was that the studies included came largely from high-income countries, with one from South Africa as the sole middle-income representative, whereas 80% of the world's disabled population lives in middle- and low-income nations, where violence rates are often higher.

Other limitations were the substantial heterogeneity in most prevalence estimates and high uncertainty around the risk estimates.

The study was funded by the World Health Organization's Department of Violence and Injury Prevention and Disability.

The researchers reported having no conflicts of interest to disclose.

Editorialists Fuller-Thomson and Brennenstuhl reported having no conflicts of interest.

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